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1992, 08-24 Permit App: 92006776 Sewer
SEWER/PLUMBING PEAR1I T APPLICATION FORM INFORMATION WORKSHEET JOB STREET ADDRES : 67' / 9/ ( �2Q�" — 4/ \91A4dd CITY/STATE/ZIP:.S&e- Ct- - PARCEL NUMBER: (A" /���v MAILING ADD SS: �'a�'� OWNER: a /S'u2� PHONE NUMBER: 91c2c0_0&5 6 -7 ��� '`1� (Street) (City/state) (Zip) CONTRACTOR:C.toueQUAvan AINE. EXCau LICENSE NUMBER: G'OLL eCCa 1-8S R-1 n PHONE NUMBER: °lag -54S5 MAILING ADDRESS: E. 1b40,2 UALL>✓ywAY flVE VeE.ADAI.0 WA- 95037 (Street) (City/state) (Zip) DESCRIPTION SEWER CONNECTION PLUMBING ALTERATIONS SIGNATURE AD" X EACH UNIT =MOUNT X 50.00 = -id ( X 35.00 = .36----- c ---e5 SUBTOTAL $ rcC�O EQUALS: TOTAL PEMIT FEE DUE Q 0-8 _$ U Spokane County Department of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509)456-3675